For transformation of lifestyle (smoking) that is action transformation, there are five stages of "the maintenance period" "the practice period" "seedtime" "the interest period" "the indifference period" (figure 1). Many expectant mothers belong for "the interest period", and they are thought to tend to be going to obtain necessary information for child care positively.
On the other hand, it is said that we compare when we do not smoke, and risks such as the low birth weight, premature birth, the perinatal death increase when pregnant woman smokes. In addition, there is report that risk of bronchitis and bronchial asthma of child increases by smoking of mother after the childbirth.
From these, it is thought that it is effective as one of the measures of the issue of cigarette and necessary to perform non-smoking, protection from smoke education for expectant mothers.
Stage of figure 1 action transformation
The source: Masakazu Nakamura, non-smoking support as lifestyle improvement measures, 2001 cigarette and child (Tokyo Health and Medical Bureau, Tokyo Metropolitan Board of Education)
It is adopted as Yokohama City Inst. of Health application type research problem (note 1) this time in 2005, and result of "study about smoking action of expectant mothers" that we carried out by plan for 2 years reports the actual situation about smoking actions such as expectant mothers and approach of cigarette education to pregnant woman.
(note 1) research that staff of Yokohama City Inst. of Health application type research institute for health becomes chief researcher, and ward Health and Welfare Center (public health center) and inspection places carry out with the staff of other departments
We performed the actual situation grasp about smoking actions such as Naka Ward, Hodogaya Ward, Isogo Ward, expectant mothers in Kohoku Ward from January through December in 2006.
When we issue mother and child health handbook in Yokohama-shi, we have having work or not, smoking action fill out "the pregnancy notification vote" to citizen's all of you on age and the expected date of pregnant woman. In addition, we have you fill out medical questionnaire about the lactation situation of baby/infant or the perinatal weight, height other than smoking action of family in "four months child Health Checkups" which is one of the infants medical examination. We arranged student attending a lecture account book of "mother (parents) classroom" which this "pregnancy contact vote" and "medical questionnaire of four months child Health Checkups" carried out in ward Health and Welfare Center more for each mother and by analyzing, in this study, grasped the actual situation of smoking actions such as expectant mothers.
In addition, we used only information about information that agreement was provided about the use for dossier because personal information was included.
Breakdown of investigation eligible people
Analysis was for 2,848 sets (44.4% of the whole) that were able to connect information of the pregnancy notification vote for each mother among 6,408 sets of mother and the child who consulted 104 times of child Health Checkups for four months when we carried out with four wards for from January, 2006 to December (table 1).
Breakdown of table 1 investigation eligible people
Change of smoking rate of mother
Smoking rate of after giving birth was higher four wards at the time of child Health Checkups medical questionnaire entry at the time of the pregnancy contact vote entry together in (the following, after giving birth) for (becoming pregnant as follows) and four months, and, person who quit smoking by the pregnancy in ki, case which reopened smoking was seen in after giving birth (table 2).
Change of smoking rate of table 2 mother
* As thing filled in to under fourth month of pregnancy (under 16 weeks) occupied 90% as for the pregnancy contact vote, it is thought that smoking action of pregnant woman provided from the pregnancy notification vote reflects thing in early pregnancy.
In addition, after checking whether age, work, childbirth mother's experience, smoking action of father affected smoking rate and the non-smoking success rate of after giving birth during the pregnancy of mother, the actual situation that was common to four wards although a part exception was seen in Naka Ward became clear (table 3). Among people who smoked during the pregnancy with the non-smoking success rate here or gave up smoking, we show ratio of person who does not smoke in after giving birth.
Factor (four wards of common points) which affects the smoking action of table 3 mother
*Ratio of person who does not smoke among people who smoked during 1 pregnancy or gave up smoking in after giving birth (the non-smoking success rate)
*There is exception in 2, *3 Naka Ward
At first, it turned out that it was higher in 20-24-year-old smoking rate than other age-grades (figure 2). But 25-29 years old was the highest in smoking rate of after giving birth of Naka Ward, and subsequently 20-24 years old and 40 years or older were observed highly. Then, mother who did not have than mother with work was higher in smoking rate (table 4), and it was revealed that the non-smoking success rate was low. Mother who delivered after later-born was smoking rate higher than mother who delivered the first child, and, about childbirth experience, it was revealed that the non-smoking success rate was low. But, as for the pregnant smoking rate of Naka Ward, mother who delivered the first child was observed highly. About smoking action of father, we obtained information from medical questionnaire of child Health Checkups for four months. Family who did not smoke from home where father smoked was lower in smoking rate of mother, and it turned out that it was high in the non-smoking success rate.
Smoking rate of figure 2 20-24-year-old mother is high (example of Isogo Ward)
Smoking rate (example of Kohoku Ward) of table 4 mother
＊There is statistical significant difference (p <0.05)
Influence on fetus whom smoking of pregnant woman gives to
Based on the weight, height, chest measurement of perinatal child, head wall, we checked whether smoking of pregnant woman affected the fetal development. When pregnant woman smoked by precedence investigation, we compared when we did not smoke, and it was reported that risks of the low birth weight increased, but difference did not have of four wards for growth of perinatal child by smoking of pregnant woman together with it was this investigation. In this, it is thought that smoking mother was very few with cause among investigation eligible people. Accumulation of information is more necessary to check smoking of pregnant woman and relations of the fetal development situation.
The situation of cigarette surrounding baby/infant
Smoking rate of family of child was 41.7% of Naka Ward, Hodogaya Ward 43.7%, Isogo Ward 44.7%, Kohoku Ward 39.2% for four months (figure 3). There were the most families (mainly father) except mother together, and four wards were 86.5% of Naka Ward, Hodogaya Ward 87.7%, Isogo Ward 85.0%, Kohoku Ward 90.3% when we saw breakdown of family who smoked.
Smoking action of figure 3 family and the breakdown (example of Hodogaya Ward)
As for the nursing situation in child Health Checkups, four wards were the highest in ratio that gave only mother's milk together for four months and were Naka Ward 56.1%, Hodogaya Ward 55.8%, Isogo Ward 56.7%, Kohoku Ward 56.3%.
After checking whether it was different in the nursing situation, ratio that we gave artificial milk (milk) in comparison with mother that mother who smoked together did not breathe four wards was high, and it was revealed that ratio that we gave only mother's milk was low by smoking action of mother of after giving birth (figure 4).
The nursing situation (example of Naka Ward) according to smoking action of figure 4 mother
The attendance situation and smoking rate of mother (parents) classroom
Ratio of mother who had attended mother (parents) classroom in mothers who delivered the first child was 47.0% of Naka Ward, Hodogaya Ward 28.0%, Isogo Ward 63.9%, Kohoku Ward 50.4%.
Tendency that was below family where four wards did not participate in home where mother participated in lesson together in smoking rate of mother and father was seen (table 5).
Smoking rate of the table 5 mother (parents) classroom attendance situation and parents
＊Eligible people of mother (parents) classroom are considered to be person planning principle, first child childbirth.
As this investigation intended only for information that agreement was provided about the use, as a result of having been provided, we did not reflect all the smoking actions such as four wards of expectant mothers. However, on the basis of such actual situation, it is thought that it is important to make policy of non-smoking, protection from smoke. For example, it is thought that what we consider reporting to the family and carry out is effective when we think about enlightenment to expectant mothers.
Smoke of cigarette is harmful to not only fetus but also child who has been had. In hope of growth of healthy child, it is necessary as possible to give child environment without cigarette.
We organized project Committee on Health and Medical Bureau (the existing Health and Social Welfare Bureau), the child care support project headquarters (the existing Child and Youth Bureau), the staff of Health and Welfare Center in 2005 and, by "study on smoking action of expectant mothers", made educational program of cigarette for pregnant women who attended mother (parents) classroom. As it was expected that smoking rate of pregnant woman who attended mother (parents) classroom was low, we took in a lot of information about harm of passive smoking. We were comprised of education video "pregnancy, child care and "cigarette"" (figure 5) and distribution thing, and educational program was carried out in Naka Ward, mother (parents) classroom of Kohoku Ward.
In addition, we did distribution quality with summary of education video and print (one piece of both-sides printing) (PDF: 223KB) about experiment (note 2) method of daikon sprouts daikon and experiment kit (kind, glass of daikon sprouts daikon, cut cotton) of daikon sprouts daikon.
Figure 5 education video "pregnant woman, child care and summary of "cigarette"" (13 minutes)
(as for the detailed contents of education video this (PDF: 646KB))
(note 2) experiment of daikon sprouts daikon
Smoking rate (2.2%) of pregnant woman (137) who received this educational program fell to after giving birth (0.7%), and it was revealed that smoking rate (33.3%) of domestic father that mother received educational program was lower than domestic father (24.1%) who did not receive educational program. However, we were not able to judge that educational program was effective clearly because originally there being few pregnant women who smoked, and having been several people and smoking rate of father before mother received educational program were unidentified.
By arranging administrative material (medical questionnaire of four months child Health Checkups, pregnancy contact vote, mother (parents) classroom student attending a lecture account book) kept with paper separately for each mother again, in this study, was able to get new information of the actual situation of smoking actions such as expectant mothers. It is thought that it was in an example of by observing information to be provided by daily duties from another angle, this being able to grasp the citizen's health situation. We want to examine method to utilize effectively in future to reflect information that I received from citizen's all of you in business of city more.
Finally by getting Naka Ward, Hodogaya Ward, Isogo Ward, cooperation of citizen's all of the Kohoku Ward, was able to carry out "study on smoking action of expectant mothers". We are very grateful to borrow this place.
October 1, 2009 publication
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